两种岛状皮瓣修复手指远节末端皮肤缺损的疗效比较

Comparison efficacy of two kinds of island flaps in repairing end skin defect of distal segment of fingers

目的比较指固有动脉逆行岛状皮瓣和指固有动脉背侧穿支岛状皮瓣修复手指远节末端皮肤缺损的效果。方法将109例手指远节末端皮肤缺损患者根据修复方法不同分为逆行岛状皮瓣组(采用指固有动脉逆行岛状皮瓣修复,54例)和穿支岛状皮瓣组(采用指固有动脉背侧穿支岛状皮瓣修复,55例),比较两组皮瓣两点辨别觉及手指功能TAM评分。结果患者均获得随访,时间12~24(18.5±2.5)个月。皮瓣全部成活,伤口及供皮瓣区均一期愈合。手术时间、术中出血量、术后12个月皮瓣两点辨别觉及手指功能TAM评分两组比较差异均无统计学意义(P>0.05)。术后6个月,两组皮瓣外形及感觉均良好,质地柔软、耐磨、无触痛、耐寒冷;供区愈合好,外观平整,无瘢痕挛缩,主、被动活动良好。术后12个月两组手指功能TAM评分优良率比较差异无统计学意义(P>0.05)。结论指固有动脉逆行岛状皮瓣和指固有动脉背侧穿支岛状皮瓣修复手指远节末端皮肤软组织缺损都是较理想的方法,临床操作中宜优先选用指固有动脉背侧穿支岛状皮瓣。

Objective To compare the effects of the proper digital artery retrograde island flap and the dorsal perforating branch of the proper digital artery island flap in repairing the end skin defects of distal segment of fingers.Methods The 109 patients who suffered from end skin defect of distal segment of fingers were randomly divided into the retrograde island flap group(54 cases were performed with retrograde island flaps of the proper digital artery)and the perforating island flap group(55 cases were performed with the dorsal perforator island skin of the proper digital artery),according to the repair method.The two-point discrimination of the flap and the TAM score of finger function were compared between two groups.Results All patients were followed up for 12~24(18.5±2.5)months.All the flaps survived,and the wound and the donor flap area healed in the first stage.There were no significant differences in operation time,intraoperative blood loss,the two-point discrimination and TAM score of finger function at postoperative 12 months between the two groups(P>0.05).At 6 months postoperation,their appearance and feeling were good,soft texture,wear-resistant,non-tender,and cold-resistant;the donor site healed well,the appearance was smooth,there were no scar contractures,and active and passive activities were good.At postoperative 12 months,there was no significant difference in the excellent-good rate of finger function TAM scores between the two groups(P>0.05).Conclusions The retrograde island flaps of the proper digital artery and dorsal perforator island skin of the proper digital artery are idealer surgical methods to repair end skin and soft tissue defects at the distal segment of fingers,and the latter should be preferred in the clinical operation.